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Flashcards in Principles of Orthopedic Assessment Deck (94):
1

mechanical trauma

external and internal forces

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external forces

tackling, wrestling, baseball to the face, can come from person to person contact

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internal forces

knock knee when landing, non contact injury

4

mechanical forces

compression
tension
shear
bending

5

compression

2 areas being pushed together, disk injuries

6

tension

2 areas being pulled apart.
ex: dislocated shoulder

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shear

surfaces rub horizontally across each other
ex: strawberries

8

bending

breaking partially and bone bends
ex: breaking collar bone

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extrinsic risk factors

coaching, environmental factors, protective equipment, specific demands

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intrinsic factors

muscle imbalance, postural defects, overuse, inadequate warm up, poor technique, age

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contractile

muscles and tendons
ex: AROM, muscle strength

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non contractile

skin, joint capsules, ligaments, cartilage, dura mater, nerve roots
ex: PROM, accessory motion of joint, joint laxity test

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accessory motion

osteokinematic (whole movement) & arthokinematic (roll and glide) movements

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layers of skin

epidermis, dermis, hypodermis (subcutaneous tissue)

15

skin injuries

friction (rubbing), shearing, compression, tearing (laceration), cutting, puncturing

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friction blister

friction causing fluid buildup under the epidermis

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abrasion

skin is scraped across a rough surface. disrupts dermis & epidermis exposing blood capillaries

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skin bruise (ecchymosis)

compressive force causes bleeding under the skin

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laceration

wound in which skin has been irregularly torn

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skin avulsion

skin that is torn by the same mechanism of laceration but the tissue is completely ripped from its source

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incision

skin is sharply cut

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puncture

penetration of skin by a sharp object

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acute muscle injuries

contusion and strains

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strains

gr.1: mild taring. microtrauma
gr.2: moderate tear, up to 50% of muscle fibers torn
gr.3: >50% tear, may require surgery

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tendonitis

tendon is sore, inflamed

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tendinosis

tendon is degenerating, looks like its getting thicker because of abnormal scare tissue

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tenosynovitis

mostly in hand and feet, while passing through synovial fluid, is inflamed

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tendon rupture

non contact, it pops because of stress (Achilles tendon)

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capsular tears

subluxation: partial dislocation
dislocation: completely

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capsulitis

"frozen shoulder"

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ligaments

dense regular connective tissue (box of spaghetti noodles)

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capsule

dense irregular connective tissue (ball of yarn) can get partially out stretched

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ligament classification

gr1 sprain: microtears, hurts to move but will be able to (7-10days)
gr2: more pain, less moving, feel laxity
gr3: totally tearing, could have medial meniscus injury

34

synovium

fluid that lubricates the joint

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synovitis

irritate and temporarily blow up with synovial fluid

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diseases attacking the synovial membrane

lupus: seeing synovial tissue as foreign and some organs
rheumatoid arthritis: controlled then flares up, usually adult disorders
JRA: can come when in middle/high school

37

hyaline cartilage

hard, translucent, high in amount of collagen & proteogylcan
covers ends of long bones
no blood supply, won't heal

38

fibrocartilage

thick collagen fibers in small chains, low content of GAG's. found in symphyseal joints, interpretable disks. has slight healing capacity (meniscal tear)

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elastic cartilage

has elastic fibers in extracellular matrix. located in the ear, spine, and neck

40

bone cell types

osteoblasts: new bone
osteoclasts: take away old bone
osteocytes:

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bone function

support body, organ protection, movement, calcium reserve, formation of blood cells

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oblique fracture

at a diagonal

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comminuted fracture

bone fragments into little pieces

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spiral fracture

break bone that sticks through skin

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grenstick fracture

incomplete fracture in which the bone is bent, often occurs in children

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impacted fracture

ends are driven into each other

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avulsion fracture

piece of tendon is still attached to bone

48

stress fracture

linear cracks in the bone from repetitive stress

49

pathologic fracture

bony tumor, comes from cancer
osteosarcoma: primary bone cancer
prostate cancer: cancer moving to another location

50

skeletal trauma: type 1

completely separation of epiphysis in relation to metaphysics without fracture to the bone (common in infants)

51

skeletal trauma: type 2

fracture/separation. separation of the growth plate with a small wedge broken off

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skeletal trauma: type 3

fracture of the epiphysis. transverse & perpendicular fracture resulting in a completed disrupted piece of bone that will be compromised to have new growth

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skeletal trauma: type 4

fracture of a portion of the epiphysis and metaphysis. same as type 3 but has broken piece extending into the shaft of bone

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skeletal trauma: type 5

crushing od the epiphyseal plate, no displacement but can cause gross deformity

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sever's disease

(apophysitis) only get it in growing years, get inflammation, over use of a chillies tendon

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osgood schlatter's disease

weakening in the growth plate

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CNS (central)

brain and spinal cord

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PNS (peripheral)

lower motor neuron
afferent: information going up
efferent: information going down

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etiology

compression or forceful over stretching

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neuropraxia

grade 1. pressing on nerve to shut it down and get tingling sensation

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axontotmesis

grade 2: lose sensation and strength for weeks or months, prolonged weakness

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neurotmesis

grade 3: full blown crush or severing of the nerve. requires surgery

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spasticity

too much tone in your muscles

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patho-anatomic

naming structures involved in injury

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biomechanical diagnosis

why the patient has that problem, what might have caused it

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local MOI

saw what happened, something happened

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regional interdependence

joints can have pathology that is linked to mechanical bones or something else

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differential diagnosis

distinguishing of a disease or condition from others presenting similar symptoms

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orthopedic assessment in clinic setting

history, observe posture, neuro screen, palpate, AROM, PROM, strength, girth (swelling or atrophy), special tests, functional tests

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red flags in an exam

severe unremitting pain, pain unaffected by medication or change in position, severe night pain, severe pain with no history of injury, saddle area numbness, losing a lot of weight for no reason, unexplained fatigue

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observation when patient does not know

able to sit comfortably? willing to move? limping? shifting weight more to one side? leaning or walking with an ezra wide base?

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observation: what to look for

deformity, hypertrophy, atrophy, scars/incisions, wounds, ecchymosis, redness, swelling, postural malalignments

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looking at postural alignment (posterior/ anterior)

no head tilt, level shoulders, no scapular winging, no C or S spinal curve, no leg length difference, foot/ankle in slight pronation

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postural alignment (lateral) plumb line

through ear, AC joint, lumbar vertebral bodies, greater trochanter, slightly anterior to axis of knee joint, slightly anterior to lateral malleolus

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sagittal plane malalignments

genu recurvatum: seen a lot in dance, calves stick out
excessive kyphosis: forward head, shoulders become hard to flex

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anterior observation (miserable malalignements)

femoral anteversion: angle created forward tilt of neck of femur. hip has to sit in internal rotation.
squinting patella
tibial external torsion

77

scoliosis (name by convex side of curve)

2 types
1. structural (teenage)
-idiopathic: unknown origin
-congenital: at birth, comes from disorder such as arthogryposis
2. functional
-get plowed from sport

78

hyper-reflexia

too much reflex (increase in stretch reflex)

79

need to do neurological screening if...

tingling, burning, loss of sensation
steps: dermatome testing and deep tendon reflex testing

80

upper motor neuron lesions CNS

problems with brain or spinal cord, inhibitory neurons not irking properly, increased response

81

lower motor neuron lesion PNS

herniated lumbar disc on L5 ventral/dorsal roots.
-decreased sensation
-decreased strength
-reflex testing will be diminished or absent
-may see significant muscle atrophy

82

dermatome

an area of skin sensation supplied by a single nerve root
-spiral shape, light & sharp touch
-can you feel sensation and is it the same on both sides

83

lower quarter dermatomes

L1-over greater trochanter
L2-front of thigh
L3-across knee
L4-medial shin, dorsum of foot
L5- lateral aspect of shin, lateral foot
S1- posterior shin, plantar aspect of foot
S2-hamstrings

84

lower quarter neuro exam

L1-L2: hip flexors
L3: quads
L4: anterior tibialis
L5: EHL/peroneals (big toe extensor)
S1: gastrocs
S2: hamstrings

85

myotome

groups of muscles supplied by a single nerve root (not painful)

86

grading scale for lower quarter neuro exam

-knee jerk: L3, L4
-achilles reflex: S1
0-absent
1-diminished
2-normal
3-hyper reflexic
4- clonus, shaking movement

87

neural special tests for lumbar spine

- SLR: straight leg raise, passive, adverse (bad) neural tension tests, puts particular nerve in stretched position, 30-75 degrees likely area to get sciatic burning
raise good leg and makes other leg burn, positive test from a disk

88

AROM

- shows willingness to move
- requires muscle contraction
- may see compensatory motions
- overpressure: when patient moves to end point and you push on them

89

PROM

- should know the total ROM available
- need to feel "end feel"

90

manual muscle testing
kendalls testing scale

- 5= normal, can't break muscle strength
- 4=good, breaks with moderate resistance
- 3+= give pretty daily ROM
- 3= fair, complete ROM against gravity only
- 2+ poor plus= initiates motion against gravity only, can't compete it
- 2= poor, full ROM gravity eliminated
- 2-= poor minus, initiates ROM gravity eliminated
- 1= trace evidence of a twitch under your palpating hand
- 0

91

diagnostic accuracy of special tests

- true positive: clinical test and the cold standard are both positive
- true negative: clinical test and the gold standard test are both negative
- false positives: test is positive even though the condition does not exist
- false negative: test shows the problem is not there, but actually is

92

functional tests

- self report questionnaires
- tasks for a certain joint (HOP or Squat test)
- sports specific testing
- gait analysis/running analysis
- throwing analysis

93

Nagi Model

- pathology
- impairments
- functional limitations
- disability

94

prognosis and treatment intervention

- prognosis: estimated time to recovery, or not
- treatment intervention: remove impairments listed and functional limitations